Department of Critical Care, University Medical Center Groningen, University of Groningen, PO Box 30.001, HPC TA29, 9700 RB, Groningen, The Netherlands.
Department of Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
BMC Res Notes. 2021 May 13;14(1):183. doi: 10.1186/s13104-021-05604-w.
Lactate has been shown to be preferentially metabolized in comparison to glucose after physiological stress, such as strenuous exercise. Derangements of lactate and glucose are common after out-of-hospital cardiac arrest (OHCA). Therefore, we hypothesized that lactate decreases faster than glucose after return-to-spontaneous-circulation (ROSC) after OHCA.
We included 155 OHCA patients in our analysis. Within the first 8 h of presentation to the emergency department, 843 lactates and 1019 glucoses were available, respectively. Lactate decreased to 50% of its initial value within 1.5 h (95% CI [0.2-3.6 h]), while glucose halved within 5.6 h (95% CI [5.4-5.7 h]). Also, in the first 8 h after presentation lactate decreases more than glucose in relation to their initial values (lactate 72.6% vs glucose 52.1%). In patients with marked hyperlactatemia after OHCA, lactate decreased expediently while glucose recovered more slowly, whereas arterial pH recovered at a similar rapid rate as lactate. Hospital non-survivors (N = 82) had a slower recovery of lactate (P = 0.002) than survivors (N = 82). The preferential clearance of lactate underscores its role as a prime energy substrate, when available, during recovery from extreme stress.
生理应激后，如剧烈运动，乳酸比葡萄糖更优先代谢。院外心脏骤停 (OHCA) 后，乳酸和葡萄糖的紊乱很常见。因此，我们假设 OHCA 后自主循环恢复 (ROSC) 后，乳酸比葡萄糖下降得更快。
我们对 155 名 OHCA 患者进行了分析。在急诊科就诊的前 8 小时内，分别获得了 843 次乳酸和 1019 次血糖检测值。乳酸在 1.5 小时内降至初始值的 50%（95%CI[0.2-3.6 h]），而葡萄糖在 5.6 小时内减半（95%CI[5.4-5.7 h]）。此外，在就诊后的前 8 小时内，与初始值相比，乳酸下降幅度大于葡萄糖（乳酸 72.6%，葡萄糖 52.1%）。在 OHCA 后出现明显高乳酸血症的患者中，乳酸迅速下降，而葡萄糖恢复较慢，而动脉 pH 以与乳酸相似的快速速率恢复。医院死亡患者（N=82）的乳酸恢复速度较慢（P=0.002），而存活患者（N=82）的乳酸恢复速度较快。乳酸的优先清除突出了其在极端应激恢复期间作为主要能量底物的作用。
